Guttate Psoriasis: What is it?

Guttate psoriasis is a form of psoriasis characterised by thin plaques with minimal scaling that form on the torso, back, and limbs. It typically occurs in children and young adults. It can occur on its own (acute guttate psoriasis) or exacerbate an existing chronic plaque psoriasis, often quite limited (outbreak of chronic plaque psoriasis in guttate form). These plaques spread rapidly over the entire body when they measure less than one centimetre. The hair and nails are spared in the majority of cases.

The droplets formed by guttate psoriasis can cause itching in the patient. After the plaques disappear, the red lesions heal quickly.

Several factors can be at the root of guttate psoriasis:

• Bacterial infection due to streptococcus : a sore throat that occurred a few weeks ago can lead to the onset of this skin rash. Streptococcus is the triggering factor for this type of condition. A virus can also be a triggering agent for this skin problem.

• Reaction to anti-INF or post-vaccination: Anti-INF are biomedicines proposed for the treatment of moderate to severe forms of psoriasis. They can lead to the onset of mild guttate psoriasis in cases of unexpected reactions. A few exceptional cases of this skin disease occur after vaccination.

• Genetic Heritage: just like other forms of psoriasis, guttate psoriasis can also be of genetic origin.

Mild guttate psoriasis progresses differently from one patient to another. The plaques can last a month and disappear, without treatment, after two to three months. Patients are divided into three categories:

• Category 1: This encompasses those who experience a single flare-up.

• Category 2 : This pertains to patients with mild guttate psoriasis that progresses into plaque psoriasis, but they do not experience a remission phase.

• Category 3 : this encompasses patients going through a period of remission (of varying lengths) before the growth of plaque psoriasis.

Generally, the patches remain for about a month and then naturally disappear within 2 to 3 months. However, in some instances, treatment may be required.

The treatment of guttate psoriasis is determined based on the causes of the disease. It can be treated with antibiotics prescribed for the management of ENT (Ear, Nose, and Throat) conditions. These medications are used when the infection is caused by streptococcus.

Local treatment for guttate psoriasis is also a viable option to combat this disease. To treat the affected area, the use of medications, prescribed by a doctor, based on dermocorticoids, either alone or in combination with calcipotriol betamethasone, may be sufficient.

When topical medications prove ineffective in treating guttate psoriasis, phototherapy can be employed as an alternative. This approach is suitable for addressing widespread and persistent psoriasis. Systematic medication intake may be prescribed by a doctor in the event of severe flare-ups.

TELFER N. R. & al. The Role of Streptococcal Infection in the Initiation of Guttate Psoriasis. Archives of Dermatology (1992).

TELFER N. R. & al. CHALMERS R. J. G. & al. A systematic review of treatments for guttate psoriasis. British Journal of Dermatology (2001).

BENETON N. Le psoriasis en gouttes. Association France Psoriasis (2023).